Provider Demographics
NPI:1932841624
Name:OLYMPIA SMILES DENTISTRY FOR ALL AGES
Entity type:Organization
Organization Name:OLYMPIA SMILES DENTISTRY FOR ALL AGES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:YATHINDRAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LINGAM-NATTAMAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-528-4488
Mailing Address - Street 1:5511 CORPORATE CENTER LN SE SUITE A
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-528-4488
Mailing Address - Fax:360-528-4490
Practice Address - Street 1:5511 CORPORATE CENTER LN SE SUITE A
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-528-4488
Practice Address - Fax:360-528-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental